A Case of Warm Autoimmune Hemolytic Anemia Secondary to Epstein-Barr Virus Infection

Abstract

Autoimmune hemolytic anemia (AIHA) is a rare disease characterized by autoantibodies directed at red blood cells. Patients typically present with anemia and are diagnosed by positive direct antiglobulin (DAT) test. AIHA is subclassified into warm or cold based on antibodies involved and depending on their optimal temperature in which they react with RBC antigens. Warm AIHA can be either primary (idiopathic) or secondary depending on etiology. Secondary causes are associated with malignancy, connective tissue and inflammatory diseases, infections (typically viral infections), or drugs (e.g., antibiotics, chemotherapeutic agents). Epstein-Barr virus (EBV) is a herpes virus that is commonly associated with cold AIHA, with only one reported case of EBV-induced warm AIHA. It has been postulated that antibodies against EBV crossreact with antigens expressed on RBC membranes and activate the complement cascade similarly. This case report describes a case of a 32-year-old male who presented with warm AIHA secondary to EBV reinfection.

Case report: Autoimmune hemolytic anemia caused by warm and cold autoantibodies with complement activation—etiological and therapeutic issues

“…A review of the literature revealed limited results on various etiological and therapeutic approaches. EBV infections were significantly associated with cold IgM-mediated AIHA (rarely with warm IgG agglutination) ( 11 ), while CMV infection is associated mainly with warm IgG-mediated AIHA. Given that EBV and CMV infections are the most probable causes of disease triggers, three possibilities arise: EBV and CMV trigger AIHA, and the complement cascade acts simultaneously but independently.…”